ObamaCare’s slow motion implosion

Health and Human Services Secretary Sylvia Burwell announced recently that she expects 10 million people to be enrolled in health-care coverage through ObamaCare’s exchanges by the end of 2016. What she didn’t mention was that in March of last year the Congressional Budget Office predicted that 21 million people would be enrolled in 2016—more than double the new estimate.

The administration says the difference can be explained away: For instance, fewer companies dropped coverage than expected, thus fewer employees are migrating from employer-sponsored plans to the exchanges. “We haven’t seen much of a shift at all,” Richard Frank, a health and human services assistant secretary, told USA Today.
But the question isn’t where Americans are getting health insurance. It is whether ObamaCare will provide more Americans with affordable insurance for decades to come.

Supporters credit ObamaCare with helping nine million uninsured Americans find coverage in 2014. But a new paper from the Heritage Foundation, however, suggests that nearly all of the increase came from adding nearly nine million people to the Medicaid rolls. In other words, ObamaCare expanded coverage in 2014 to the extent that it gave people free or nearly free insurance. That goal could have been accomplished without the Affordable Care Act. To justify its existence, ObamaCare must make affordable private insurance available to a broad cross-section of uninsured Americans who are ineligible for Medicaid. But with fewer people buying insurance through the exchanges, the economics aren’t holding up. Ten of the 23 innovative health-insurance plans known as co-ops—established with $2.4 billion in ObamaCare loans—will be out of business by the end of 2015 because of weak balance sheets.

And while rates vary widely by state, the cost for private insurance through the exchanges is also increasing dramatically. An analysis by consulting firm Avalere Health released on Friday shows that some of the most popular insurance plans in the ObamaCare exchanges will experience double-digit premium hikes in 2016. One problem is that nearly half of the 10.5 million uninsured people eligible for ObamaCare are between the ages of 18 and 34—and young people tend to be healthy and unwilling to pay for pricey coverage they don’t need. But propping up ObamaCare requires this group’s subsidizing the medical costs of the aging and ill. So far, no luck. It makes sense for healthy young people to pay a penalty rather than purchase the insurance. And in 2015 that’s what 6.6 million people did, according to the IRS. Next year the minimum penalty increases to $695 or 2.5% of income above $10,000, whichever is greater. In many cases, that’s still much cheaper than insurance.

At our company, CKE Restaurants, we offer eligible employees ObamaCare-compliant coverage. We used federal guidelines and set our employee monthly contribution for the least expensive Bronze plan at $1,116 a year, or about 25% of the annual premium. The company pays the rest, and the deductible is $5,500. But even when next year’s higher penalty kicks in—2.5% of income above $10,000—an employee would need to earn more than $50,000 a year for the penalty to exceed the premium.
Then there is another problem: It is easy to avoid or limit exposure to the penalty with some simple tax planning, as there are 30 different exemptions (which 12 million people claimed last year) and the IRS collects the penalty by reducing an employee’s tax refund.

The uninsured also know they can receive medical care at the emergency room. And if they fall ill, they can always purchase insurance during the next enrollment period, because ObamaCare eliminated existing conditions as a justification for denying coverage.

Our employees are smart enough to figure this out. Of our company’s 5,453 eligible employees, only 420 enrolled. Our experience isn’t unique, according to press reports. A March survey by the consulting firm Mercer found “virtually no change between 2014 and 2015” in the average percentage of employees signed up for employer-sponsored health plans. Mercer found a 1.6% increase in the absolute number of enrolled employees, but that happened thanks to a growing workforce, not the law.

How have things changed under ObamaCare? Wealthy Americans continue to have health insurance, albeit at a higher price. But they can afford it. Many middle-class Americans are paying higher premiums they can hardly afford. And then millions more low-income Americans have heavily subsidized insurance or Medicaid coverage.
However, millions of other Americans who enjoyed good individual insurance before ObamaCare have found themselves forced out of affordable plans, with their new premiums rising rapidly. Other middle- and working-class Americans who were uninsured are still uninsured and paying the penalty or claiming an exemption. That isn’t affordable care. In many cases, it isn’t care at all.
Mr. Puzder is the chief executive officer of CKE Restaurants.